title: A 12 year (1998-2009) antibiotic resistance surveillance of Klebsiella pneumoniae collected from intensive care and urology patients in 14 Dutch hospitals.
abstract: OBJECTIVE
  We evaluated the changes in antibiotic resistance from 1998 to 2009 of Klebsiella pneumoniae isolated from the intensive care units (ICUs) and urology services of 14 Dutch hospitals and the consequences for empirical therapy.
  
  
  METHODS
  Quantitative antibiotic susceptibility testing of K. pneumoniae was performed in a central laboratory using a microbroth dilution method. Breakpoints were as defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). The prevalence of extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing isolates was determined.
  
  
  RESULTS
  A significant increase in resistance among ICU isolates was observed for ceftazidime (4.2%-10.8%), ciprofloxacin (5.8%-18.5%) and trimethoprim/sulfamethoxazole (11.9%-23.1%), and for cefuroxime (2.8%-7.9%) and trimethoprim/sulfamethoxazole (13.5%-27.8%) among urology isolates. Among ICU isolates the prevalence of ESBLs increased significantly from 2% to 8%. Carbapenemase production was not demonstrated. Among ICU isolates the prevalence of multidrug resistance increased and has been ≥12% since 2004. Among urology isolates multidrug resistance was highest in 2009 at 7.4%. Overall, resistance was significantly higher among ICU isolates.
  
  
  CONCLUSIONS
  We observed an increase in resistance among ICU and urology isolates and an increased prevalence of ESBLs among ICU isolates. Carbapenemase production was not demonstrated. A regular update of empirical treatment protocols based on actual surveillance data is justified.
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: C F M
authors.initials: CF
authors.lastname: van der Donk
authors.forename: P S
authors.initials: PS
authors.lastname: Beisser
authors.forename: J A A
authors.initials: JA
authors.lastname: Hoogkamp-Korstanje
authors.forename: C A
authors.initials: CA
authors.lastname: Bruggeman
authors.forename: E E
authors.initials: EE
authors.lastname: Stobberingh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016638:Critical Illness; D024881:Drug Resistance, Bacterial; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D009426:Netherlands; D014552:Urinary Tract Infections / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents